FACT SHEET

Health and Education Office

Fertility Awareness for Community Transformation

(FACT) Project
BACKGROUND
Nepal’s Demographic and Health Survey 2011 (NDHS) showed that,
although women report almost universal knowledge of family planning
methods (99 percent of women are aware of at least one method of family
planning), there is a high level of unmet need for family planning (27 percent).
NDHS also showed that only 25 percent of women can correctly identify the
time of month in which they are most likely to become pregnant - also
known as their ‘fertile window.’ Moreover, hard-to-reach populations have
particularly low levels of contraceptive use. New approaches are needed to
reach these groups. Janajatis, Dalits, and Muslims tend to experience higher
total fertility rates and lower contraceptive prevalence rates than the national
average. Additionally, 21 percent of births occur with suboptimal spacing- Group interaction during landscape assessment
that is, less than two years after the mother’s previous birth - increasing the
risk of child and maternal complications and deaths. Adolescent pregnancy, which carries higher risks to both mothers and
babies, is also high: by age 19, 39 percent of women have given birth.

PROJECT OVERVIEW
The USAID-supported Fertility Awareness for Community Transformation (FACT) Project is a five-year, global research,
intervention, and technical assistance project that is developing and testing unique interventions in Nepal, India, Rwanda, and
Uganda. The interventions are investigating two primary hypotheses:
1. Increased fertility awareness improves family planning use.
2. Expanded access to fertility awareness-based methods (FAM) increases the use of family planning and reduces
unintended pregnancies.

The FACT project seeks to:

 Improve women’s and men’s understanding of the risk of pregnancy at different times during a woman’s life.
 Increase understanding of how family planning methods work to counter concerns, myths, and misperceptions.
 Expand access to the Standard Days Method® (SDM) i, which may be more acceptable to hard-to-reach groups.

THE INTERVENTIONS
In Nepal, the FACT approach includes taking two related but unique strategies to increase fertility awareness and family
planning use. Both solutions will be guided by key stakeholders, service providers, and the communities in need through a
research-based approach whose activities can easily be scaled up.

Approach 1: Community Mobilization through Existing Networks

 U.S. Agency for International Development 2

 The Community Mobilization through Existing Networks intervention aims to increase fertility awareness to improve
family planning use. Fertility awareness involves both actionable information about fertility throughout life and the
ability to apply this knowledge to one’s own circumstances and needs. Applying this information to one’s life requires
individual knowledge, personal experience and skills, as well as an environment within the family and community that
enables people to undertake appropriate actions.
 Qualitative research in five districts (Pyuthan, Siraha, Rupandehi, Nuwakot and Bajura) will guide the design of simple,
effective, and easy-to-diffuse behavior change approaches to increase fertility awareness and use of family planning.
Local creative experts will lead the design of a data-based, locally driven intervention. Continued engagement with
partners and local officials will ensure the integration of those activities into existing groups/networks, such as
mothers’ groups, health facility management committees, and facilitate a rigorous evaluation process.

Approach 2: Roving Auxiliary Nurse Midwife (ANM) and Standard Days Methods (SDM) Integration
 This approach will test the deployment of Roving ANMs to share family planning methods with difficult-to-reach and
underserved groups, such as Muslims and the urban poor in Rupandehi district. This testing will be carried out in
partnership with the Ministry’s Family Health Division and District Public Health Office and will be implemented in
parallel to the fertility awareness activities in Rupandehi that started in 2015 and will continue through 2018. TheSDM
method will be integrated into the existing family planning services those offices already provide This research will test
the feasibility and cultural acceptability of both SDM and CycleBeads®ii among hard-to-reach groups.
 FACT is investigating local perceptions and demand-side factors to guide marketing, distribution and pricing for
CycleBeads. FACT will apply the conclusions derived from this study to guide the development of contextually and
culturally appropriate messaging for SDM and CycleBeads, and will shape the packaging and possible price points
necessary to ensure a sustainable integration of this family planning method into the mix of family planning methods
currently available in Bardiya and Banke, with support from Nepal Contraceptive Retail Sales (CRS), a Nepali social
marketing organization.

PROJECT ACTIVITIES
CONTACT
Approach 1:
U.S. Agency for International
 Situation assessments Development
 Formative research to inform the intervention design. G.P.O. Box 295, Brahma Cottage,
 Intervention design workshop. Maharajgunj, Kathmandu, Nepal
Tel: +977-1-4234000
 Concept developing and proof of concept testing. Fax: +977-1-4007285
 Piloting of solution, monitoring and evaluation. Email: usaidnepal@usaid.gov
www.usaid.gov/nepal
www.facebook.com/usaidnepal
Approach 2: www.twitter.com/usaidnepal
 Formative research
 Capacity building – materials adaptation/preparation and training. FACT project, Nepal
Save the Children
 Hold intervention planning meeting with findings from formative research. 1st floor | Airport Gate Area, Shambhu
 Piloting of approach. Marg Kathmandu, Nepal
Tel: +977-1- 4468130/4464803
Fax: +997-1-4468132
PLANNED OUTCOME Email: nlimbu.irh@gmail.com
 Improved use of family planning.
i Standard Days Method® (SDM) is a natural modern family planning method based on the knowledge of the days in a woman’s menstrual cycle when she is likely to become pregnant
(fertile days). SDM uses CycleBeads to help a woman track which day of her menstrual cycle she is on and whether she is likely to get pregnant that day. Those women who have
menstrual cycles between 26 and 32 days long consider days 8 through 19 as the fertile days of the cycle. To prevent pregnancy, couples use condoms or do not have sex during
those fertile days.
ii CycleBeads® is a string of 32 color-coded beads, with each bead representing a day of a woman’s menstrual cycle. This tool helps women track their cycle to know when they are

fertile and monitor cycle length. It has proven to be an important factor in gaining men’s support to use the method, as it helps them to literally see when the woman is on a fertile
day.